Doctors Treating Alcohol Afflictions In Medical Terms

December 27, 1985|By Nadine Brozan, New York Times

NEW YORK — The 21-year-old college student was failing her courses and feeling depressed. She dropped out of school and consulted a psychiatrist. ''He said, 'No cause to worry' -- I was just suffering from adolescent problems and from the fact that I had been small as a child,'' the woman said the other day. ''I told him that I was drinking and taking drugs -- marijuana, LSD -- but he didn't want to discuss that at all.''

A year later, the woman, who asked that her name not be used, consulted another psychiatrist. ''This one told me I was going through an identity crisis and simply needed time to work things out for myself,'' she recalled. Again, although she candidly described her dependence on alcohol and drugs, the doctor dismissed it.

So did other physicians she consulted over the next several years for various ailments. Six more years elapsed, and finally a psychiatrist -- whose name she had found in the Yellow Pages -- said, ''Do you have a problem with alcohol?'' and referred her to Alcoholics Anonymous. ''I have been sober ever since,'' the woman said.

The stone wall that this patient encountered is not unusual. For the most part, authorities on alcoholism say, physicians have failed to detect excessive drinking by patients. When they have uncovered the problem, they have not known what to do about it. Even among doctors who recognized the symptoms, there was a tendency to ignore them or to believe that alcoholics need only use a little willpower. Many physicians have viewed alcoholism as a moral failing and not a medical, biological, psychological and social condition.

During the last decade, however, change has slowly come to the field of addiction treatment. Now the vast number of conditions provoked or exacerbated by alcoholism are being acknowledged and diagnosed, and there is a growing realization that alcoholism is eminently treatable.

As Dr. Robert G. Niven, director of the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md., said, ''Though we still fall far short of the ideal -- integration of education about alcohol and drug consumption into all medical and health professional schools -- the situation is improving.''

The statistics are not encouraging, however, as Dr. David C. Lewis, president of the Association of Medical Education and Research in Substance Abuse, found when he surveyed the medical literature. ''Some 20 to 40 percent of general-hospital admissions involve individuals with serious drinking or drug problems, most of them alcohol, as do 10 to 15 percent of ambulatory cases and 40 to 60 percent of emergency-room visits,'' Lewis said. ''But the actual diagnosis of the disorder is made in less than 5 percent of cases.''

''The implication is clear,'' said Lewis, professor of medicine and community health at Brown University in Providence, R.I., ''that physicians are mainly treating the complications of drinking without necessarily focusing on the treatment for those behaviors.'' Amersa, as Lewis' organization is known, convened recently in California to discuss what primary-care physicians ought to know and how to implement curriculum improvements.

Lewis and his colleagues are optimistic. As Dr. Charles Rorhis, director of substance-abuse treatment at the New York Veterans Administration Medical Center, said: ''None of us dealing with this problem day in and out will ever feel that the approach of the medical profession is as good as we want it to be, but over the last 10 years, things have changed quite a bit. Doctors are more sensitive to problems associated with alcohol.''

''There are more treatment resources available,'' he said, ''more hospital beds for detoxification, more in-patient rehabilitation programs, more outpatient services, more community-based programs, psychotherapy clinics, therapeutic communities, halfway houses and free-standing specialty hospitals that deal only with alcohol. Third-party reimbursement has become available, and there is the whole self-help movement. Active research is continuously providing new information.''

In the past, medical students generally spent a few hours on alcoholism during the course of their four years of study. But that has changed, in part because of the Career Teacher Program, which was financed by the federal government from 1971 to 1982. Under that program, faculty members from about 60 schools received grants to develop new courses or expand existing ones.